Abstract
Since 2003, an epidemic of lymphogranuloma venereum (LGV) has been ongoing in men who have sex with men (MSM) in Europe. Of 92,271 MSM consulting sexually transmitted disease (STI) clinics in the Netherlands between 2006 and 2011, 63,228 (68%) were tested for anorectal Chlamydia infection, with 6,343 (10%) positive diagnoses. In 4,776 of those (75%), LGV testing was performed, with regional variation from 7% to 97%. In total 414 LGV cases were diagnosed, a mean annual positivity rate of 8.7%, decreasing from 14% in 2007 to 6% in 2011, but increasing to 13.1% during 2012 (184 new cases). Risk factors for LGV were human immunodeficiency virus (HIV) positivity (odds ratio (OR)=4.1; 95% confidence interval (CI): 3.2–5.3), STI symptoms (OR=4.1; 95% CI: 3.1–5.4), more than 50 sex partners in the past six months (OR=3.7; 95% CI: 1.1–12.4), older age (40–44 years: OR=2.1; 95% CI: 1.5–2.8), no condom use (OR=2.2; 95% CI: 1.2–3.9) and homosexuality (as opposed to bisexuality; OR=2.2; 95% CI: 1.1–4.2). Regional differences in LGV testing rates limit national LGV surveillance, leading to an underestimation of the real incidence. Characteristics of MSM with LGV did not change over time, so existing prevention strategies should be intensified.
Highlights
Men who have sex with men (MSM) are generally considered to be at increased risk for a range of sexually transmitted infections (STIs), including gonorrhoea and human immunodeficiency virus (HIV) infection [1]
This study aims to provide an update on how the epidemic of lymphogranuloma venereum (LGV) among MSM in the Netherlands developed over the period from January 2006 to December 2012, and its implications for current and future control policy, by analysing quantitative STI surveillance data
Since the proportion of MSM with an anorectal chlamydia infection tested for LGV remained stable over time, the increase seems to be a real increase in positivity rate, rather than an increase due to more diagnostic testing
Summary
Men who have sex with men (MSM) are generally considered to be at increased risk for a range of sexually transmitted infections (STIs), including gonorrhoea and human immunodeficiency virus (HIV) infection [1]. This is supported by the observation that in the Netherlands in 2010, 19% of MSM attending an STI clinic were diagnosed with one or more STIs, compared with 12% of heterosexual attendees [1]. The 1,693 cases reported during this epidemic showed several similarities: they were all male, MSM, over 25 years-old, and the majority (80–100%) was HIV-positive [6]. After careful investigation of this first Dutch outbreak, sexual contacts of these patients were traced to Belgium, France, Germany and the United Kingdom [4], which could explain the rapid spread of the disease throughout Europe
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